If you’re a woman going through menopause, changing hormone levels can make your heart pound and flutter. A pounding or fluttering heartbeat is called heart palpitations. Palpitations often start when you’re in the middle of a hot flash, which is another common menopause symptom.

Learn the possible causes of heart palpitations during menopause and what to do if you experience them.

Palpitations feel like your heart is beating much faster than usual, almost as if you’ve been running very hard. Your heart might also skip beats or flutter. The pounding feeling can radiate from your chest all the way up into your neck and throat.

Along with palpitations, you’ll likely have other menopause symptoms, such as:

hot flashes, or a feeling of intense heat, along with sweating and red skin

Doctors believe this is because high estrogen levels before menopause protect the blood vessels from damage. Once estrogen production stops, this protection is lost, and your risk for a heart attack and stroke goes up. A healthy diet, exercise, and quitting smoking all help reduce this risk.

In some women, palpitations might be an early warning of heart problems. One study found that palpitations were related to hardening of the arteries, called atherosclerosis. This condition can lead to heart attack and stroke.

Some women find that hormone replacement therapy decreases their palpitations, as it treats other symptoms of menopause like hot flashes and vaginal dryness. Yet this treatment can pose an increased risk for heart disease, stroke, and blood clots, as well as breast cancer. Discuss hormone therapy with your doctor to see if it’s right for you.

During menopause and beyond, you need to be more aware of your heart health. Follow these tips to protect your heart:

Walk, ride a bike, swim, or do other aerobic exercises 30 minutes a day, at least five days a week.